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Bohlin KS, Brännström M, Dahm‐Kähler P. Gynecological cancer during pregnancy-From a gyne-oncological perspective. Acta Obstet Gynecol Scand 2024; 103:761-766. [PMID: 38183316 PMCID: PMC10993343 DOI: 10.1111/aogs.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
Gynecological cancer diagnosed during pregnancy requires accurate diagnosis and staging to determine optimal treatment based on gestational age. Cervical and ovarian cancers are the most common and multidisciplinary team collaboration is pivotal. Magnetic resonance imaging and ultrasound can be used without causing fetal harm. In cervical cancer, early-stage treatments can often be delayed until fetal lung maturation and cesarean section is recommended if disease prevails, in combination with a simple/radical hysterectomy and lymphadenectomy. Chemoradiotherapy, the recommended treatment for advanced stages, is not compatible with pregnancy preservation. Most gestational ovarian cancers are diagnosed at an early stage and consist of nonepithelial cancers or borderline tumors. Removal of the affected adnexa during pregnancy is often necessary for diagnosis, though staging can be performed after delivery. In selected cases of advanced cervical and ovarian cancers, neoadjuvant chemotherapy may be an option to allow gestational advancement but only after thorough multidisciplinary discussions and counseling.
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Affiliation(s)
- Katja Stenström Bohlin
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Mats Brännström
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Pernilla Dahm‐Kähler
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
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2
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Morita N, Matsushita H, Yabushita H, Wakatsuki A. Recurrent Serous Borderline Tumor After Fertility-Sparing Surgery Following Twin Pregnancy and Resumption of Menstruation. Cureus 2024; 16:e52296. [PMID: 38357044 PMCID: PMC10865151 DOI: 10.7759/cureus.52296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Gynecologic malignancies sometimes affect women before menopause. Aggressive treatments, such as surgery, chemotherapy, and/or radiotherapy, often lead to premature menopause. Hormone replacement therapy (HRT), typically used for managing menopause-associated health issues, may be limited by tumor sensitivity to estrogen. Here, we present a case of a 37-year-old woman seeking fertility, who was diagnosed with a serous borderline ovarian tumor (BOT). Fertility-preserving surgery and in-vitro fertilization resulted in a twin pregnancy. During a postpartum amenorrheic period, there was no recurrence. However, she experienced a rapid recurrence of the disease following the resumption of menstruation and underwent radical surgery. This rapid recurrence after menstruation resumed suggests potential estrogen sensitivity. Close postoperative monitoring has been ongoing without HRT.
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Affiliation(s)
- Noriko Morita
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, JPN
| | - Hiroshi Matsushita
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, JPN
| | - Hiromitsu Yabushita
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, JPN
| | - Akihiko Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Nagakute, JPN
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3
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Mergel F, Schochter F, DeGregorio N, Janni W, Reister F, Friebe-Hofmann U, Hüner B. [Hyperreactio Luteinalis and an Incidentally Detected FIGO IIIB Borderline Tumor of the Ovary in Pregnancy - Diagnostic, Therapy and Review of Literature]. Z Geburtshilfe Neonatol 2023; 227:390-397. [PMID: 37130551 DOI: 10.1055/a-2065-0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Adnexal masses affect 2-10% of all pregnancies. The highest incidence of 1-6% can be seen in the first trimester, with a high rate of spontaneous remission. Two percent of these masses are malignant neoplasms or borderline tumors. A rare benign mass of the adnexa in pregnancy is hyperreactio luteinalis characterised by bilateral, multicystic ovaries with a frequent occurrence in the 3rd trimester. Clinical signs include maternal hyperandrogenaemia with virilisation, hyperemesis, nonspecific abdominal pain or laboratory findings of hyperthyroidism and elevated ß-HCG. Hyperreactio luteinalis does not require therapy due to complete spontaneous remission postpartum, but is often treated surgically in graviditate. In our case we report a first-time gravida in the 31st week of pregnancy with a symptomatic 25-cm multicystic, partly solid mass. After antenatal corticosteroid therapy, an exploratory laparotomy with right adnexectomy was performed on suspicion of malignancy. Histology revealed a hyperreactio luteinalis with an incidental finding of a serous borderline tumor of the ovary (FIGO IIIB). At 33 weeks of gestation, a pathological CTG was observed, and an urgent secondary caesarean section by re-longitudinal laparotomy was performed. Postpartum completion surgery revealed no further neoplastic cells.
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Affiliation(s)
- Franziska Mergel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Fabienne Schochter
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Nikolaus DeGregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - Wolfgang Janni
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Frank Reister
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Beate Hüner
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum am Gesundbrunnen, Heilbronn, Germany
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4
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Causa Andrieu PI, Wahab SA, Nougaret S, Petkovska I. Ovarian cancer during pregnancy. Abdom Radiol (NY) 2023; 48:1694-1708. [PMID: 36538079 PMCID: PMC10627077 DOI: 10.1007/s00261-022-03768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 05/01/2023]
Abstract
Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging and histopathology, which can mimic malignancy, and the potential side effects to the mother and fetus, whether expectant management versus surgery is pursued. Ultrasonography with Doppler evaluation is the modality of choice for evaluating adnexal masses during pregnancy. Magnetic resonance imaging is the second-line modality useful when US findings are inconclusive/indeterminate. Most adnexal masses in pregnant patients are benign in origin (e.g., functional cysts, mature cystic teratoma, decidualization of endometrioma), but a few are malignant in origin (e.g., dysgerminoma, granulosa cell tumor). Most cases of adnexal masses are asymptomatic, but complications such as ovarian torsion can occur. This review aims to familiarize the radiologist with the imaging of adnexal lesions during pregnancy so that the radiologist can identify ovarian cancer. Specifically, the review will detail the most common benign and malignant adnexal masses in pregnancy, mimickers, and their corresponding imaging findings on US and MRI.
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Affiliation(s)
- Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Stephanie Nougaret
- Department of Radiology, Cancer Institute of Montpellier, Montpellier, France
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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5
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Della Corte L, Mercorio A, Serafino P, Viciglione F, Palumbo M, De Angelis MC, Borgo M, Buonfantino C, Tesorone M, Bifulco G, Giampaolino P. The challenging management of borderline ovarian tumors (BOTs) in women of childbearing age. Front Surg 2022; 9:973034. [PMID: 36081590 PMCID: PMC9445208 DOI: 10.3389/fsurg.2022.973034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Borderline ovarian tumors (BOTs) account for approximately 15% of all epithelial ovarian cancers. In 80% of cases the diagnosis of BOTs is done at stage I and more than a third of BOTs occurs in women younger than 40 years of age wishing to preserve their childbearing potential; the issue of conservative surgical management (fertility-sparing treatment) is thus becoming of paramount importance. At early stages, the modalities of conservative treatment could range from mono-lateral cystectomy to bilateral salpingo-oophorectomy. Although cystectomy is the preferred method to promote fertility it can lead to an elevated risk of recurrence; therefore, an appropriate counseling about the risk of relapse is mandatory before opting for this treatment. Nevertheless, relapses are often benign and can be treated by repeated conservative surgery. Besides the stage of the disease, histological subtype is another essential factor when considering the proper procedure: as most mucinous BOTs (mBOTs) are more commonly unilateral, the risk of an invasive recurrence seems to be higher, compared to serous histotype, therefore unilateral salpingo-oophorectomy is recommended. In the appraisal of current literature, this review aims to gain better insight on the current recommendations to identify the right balance between an accurate staging and an optimal fertility outcome.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
- Correspondence: Antonio Mercorio
| | - Paolo Serafino
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Maria Borgo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Marina Tesorone
- Department of Child and Adolescent Health, U.O.C Protection of Women's- ASL Napoli 1, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Silva EG, Lawson BC, Ramalingam P, Liu J, Shehabeldin A, Marques-Piubelli ML, Malpica A. Precursors in the Ovarian Stroma, Another Pathway to Explain the Origin of Ovarian Serous Neoplasms. Hum Pathol 2022; 127:136-145. [DOI: 10.1016/j.humpath.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
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Kalampokas E, Vlahos N, Kalampokas T, Gurumurthy M. Common Malignancies During Pregnancy: A Comprehensive Review. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:103-109. [PMID: 35399318 DOI: 10.21873/cdp.10015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 01/31/2023]
Abstract
Malignant disease complicates pregnancy in up to 1 per 1,000-2,000 cases. Pregnancy itself does not constitute a predisposing factor for malignancy. Management and treatment of patients suffering from a malignancy during pregnancy still represents a challenge in everyday clinical practice. Recent advances in imaging, diagnostic and overall treatment modalities have tailored the management of patients, specifically those who wish to maintain the pregnancy. The aim of this review was to provide clinicians with concise information on the management of the most common malignancies during pregnancy. We performed a review of the current literature including review articles, original research articles and guidelines, which are used for the management of the most common malignancies during pregnancy. Breast, cervical and ovarian malignant tumours are the most common during pregnancy. However, the overall outcome and survival per stage for these cancers do not appear to be influenced by pregnancy. Ethical, emotional and treatment dilemmas may be encountered during treatment planning. Individualization of treatment planning should be made by a multidisciplinary team but the final decision rests with the parents.
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Affiliation(s)
| | - Nikolaos Vlahos
- Department of Obstetrics and Gynaecology, Aretaieio Hospital, Athens, Greece
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Cheikh TE, Hamza K, Rajaa E, Amine L, Karima F, Said B. Borderline serous tumor of the ovary discovered during pregnancy: A case report. Int J Surg Case Rep 2021; 84:106099. [PMID: 34139425 PMCID: PMC8213893 DOI: 10.1016/j.ijscr.2021.106099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction OFTs are tumors with low malignant potential. They represent 10 to 15% of all epithelial tumors of the ovary. Their mean age of occurrence is less than 10 years than that of carcinomas. Case report a 29-year-old female patient, second gesture, with no particular pathological history, consulted for pelvic pain occurring during a pregnancy of 8 SA + 5 days. The examination showed an abdominal-pelvic mass lateralized to the left with an enlarged uterus. Abdomino-pelvic ultrasound showed an evolving mono-fetal pregnancy of 10 weeks of amenorrhea, with two right and left latero-cystic solid formations measuring successively 4 × 4.3 cm and 8.99 × 8.25 cm. Pelvic MRI showed a left latero-uterine solid-cystic mass measuring 8.1 × 6.1 × 7 cm. An exploratory laparotomy was performed after the 16th week of amenorrhea revealed a left solid cystic ovarian mass of 10 cm. A left adnexectomy was performed with a right ovarian biopsy, peritoneal biopsy, epiploic biopsy and peritoneal cytology. The pathology report confirmed a borderline serous tumor of the left ovary on the left annexectomy specimen. The right ovary, epiploic and peritoneal biopsy is without tumor proliferation and the peritoneal fluid is acellular. Discussion OFT are characterized by their occurrence in women of childbearing age, with an increasingly advanced maternal age for the first pregnancy. Most adnexal masses are diagnosed during the first or second trimester and endovaginal ultrasound in the first trimester is the first-line examination for optimal characterization. Magnetic resonance imaging (MRI) is the recommended second-line examination from 12 weeks of age, in the presence of complex or indeterminate lesions that may be sufficient to distinguish OFMT. Surgical exploration of radiologically highly suspicious adnexal masses during pregnancy is indicated after 15 weeks of amenorrhea, to reduce the risk of miscarriage by alteration of the luteal function of the cyst in the first trimester. Conclusion The occurrence of OFT remains rare during pregnancy, which justifies the exploration of any adnexal mass discovered in the peripartum period, for which imaging plays an indispensable role in orienting the diagnosis. FTOs are tumors with low malignant potential. Their average age is 10 years younger than that of carcinomas and their appearance during pregnancy is probably related to the advanced age of the mother at the time of the first pregnancy. Pelvic ultrasound is the first-line examination for the diagnosis and evaluation of OFL during pregnancy, in the 1st or 2nd trimester, and magnetic resonance imaging (MRI) is the recommended second-line examination from 12 weeks of gestation. L'exploration chirurgicale des masses annexielles radiologiquement suspectes pendant la grossesse est indiquée après 15 SA pour réduire le risque de fausse couche due à l'altération de la fonction lutéale du kyste au cours du 1ier trimestre. The histological nature of the cyst is comparable to that encountered outside pregnancy, with a predominance of serous tumors. The type of surgical treatment depends on the desire for pregnancy, the bilateral nature of the tumour and the criteria for aggressiveness, which could explain unilateral adnexectomy during pregnancy in the case of unilateral tfo with staging surgery.
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Affiliation(s)
- Telmoudi Ely Cheikh
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Kiram Hamza
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Elqasseh Rajaa
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Lamrissi Amine
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Fichtali Karima
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Bouhya Said
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
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9
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Borderline ovarian tumor in pregnancy: can surgery wait? A case series. Arch Gynecol Obstet 2021; 304:1561-1568. [PMID: 33950305 DOI: 10.1007/s00404-021-06080-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the characteristics of borderline tumors (BOT) diagnosed during pregnancy, as either first diagnosis or relapse, to evaluate safety of expectant management. METHODS 15 women affected by BOT during pregnancy were included, to evaluate clinical and histo-pathological characteristics. Age of patient, parity, gestational age, follow-up time, size of tumor, surgical approach, type and timing of surgery, FIGO stage, and histologic type were obtained through retrospective review. RESULTS All patients except one were diagnosed with serous BOT (BOTs). Median follow-up time was 147 ± 57 months. Eight women received first diagnosis of BOT and seven had diagnosis of BOT recurrence during pregnancy, including three with a second relapse and four with a third relapse. BOT were diagnosed at FIGO stage I in most patients (75%) of the first group and in 14.3% of the second group, respectively. Micropapillary pattern was present in 71.4% of patients with first diagnosis of BOT, but only in 14.2% in case of relapse. All relapses were BOTs. No patient with BOT and concomitant pregnancy developed an invasive recurrence later. Overall, 24 relapses occurred in 10 patients (66.7%). Altogether 24 pregnancies occurred during follow-up, with a high livebirth rate (91.6%) and only 2 spontaneous miscarriages. CONCLUSION According to our experience, an "expectation management" could be a safe option in case of both relapse of BOTs during pregnancy and first suspicion of BOT in pregnant women at advanced gestational age.
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10
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Gerasimova AA, Klimenko PA. Sonographic features of ovarian tumors in pregnant women before surgical intervention and chemotherapy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.
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Affiliation(s)
- AA Gerasimova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - PA Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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11
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Primary and recurrent serous borderline tumors during pregnancy: a case report and literature review. Int Cancer Conf J 2021; 10:160-169. [PMID: 34221825 DOI: 10.1007/s13691-021-00471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022] Open
Abstract
The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7 weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39 weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13 weeks of gestation, which demonstrated recurrence of the serous borderline tumor. She gave birth to a healthy baby at 39 weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.
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12
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Franciszek Dłuski D, Mierzyński R, Poniedziałek-Czajkowska E, Leszczyńska-Gorzelak B. Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review. Cancers (Basel) 2020; 12:E3795. [PMID: 33339178 PMCID: PMC7765590 DOI: 10.3390/cancers12123795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Lubelskie Region, Poland; (R.M.); (E.P.-C.); (B.L.-G.)
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13
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Zilliox M, Lecointre L, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Lavoue V, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C, Lapointe M, Akladios C. Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study. Eur J Obstet Gynecol Reprod Biol 2020; 256:412-418. [PMID: 33296755 DOI: 10.1016/j.ejogrb.2020.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. MATERIALS AND METHODS A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. RESULTS The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. CONCLUSION BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
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Affiliation(s)
- M Zilliox
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France.
| | - L Lecointre
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France; I-Cube UMR 7357 Science Laboratory, Strasbourg, France; IHU: Institute for Minimally Invasive Hybrid Image Guided Surgery, Strasbourg, France
| | - H Azais
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - M Ballester
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - P A Bolze
- Department of Gynaecology, University Hospital South Lyon, Pierre-Bénite, France
| | - N Bourdel
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - A Bricou
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - G Canlorbe
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - X Carcopino
- Department of Gynaecology, La Timone Hospital, Marseille, France
| | - P Chauvet
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - P Collinet
- Department of Gynaecology, Jeanne de Flandres Hospital, Lille, France
| | - C Coutant
- Centre de Lutte Contre le Cancer, Dijon, France
| | - Y Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - L Dion
- Department of Gynaecology, University South Hospital, Rennes, France
| | - T Gauthier
- Department of Gynaecology, University Hospital, Limoges, France
| | - O Graesslin
- Department of Gynaecology, University Hospital, Reims, France
| | - C Huchon
- Department of Gynaecology, Intercommunal Hospital of Poissy, Poissy, France
| | - M Koskas
- Department of Gynaecology, Bichat Hospital, Paris, France
| | - V Lavoue
- Department of Gynaecology, University South Hospital, Rennes, France
| | - M Mezzadri
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - C Mimoun
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - L Ouldamer
- Department of Gynaecology, University Hospital of Tours, Tours, France
| | - E Raimond
- Department of Gynaecology, University Hospital, Reims, France
| | - C Touboul
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - M Lapointe
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
| | - C Akladios
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
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Wang L, Huang S, Sheng X, Ren C, Wang Q, Yang L, Zhao S, Xu T, Ma X, Guo R, Sun P, Lin Y, Li Y, Wang J, Wang Y. Malignant Ovarian Tumors During Pregnancy: A Multicenter Retrospective Analysis. Cancer Manag Res 2020; 12:10841-10848. [PMID: 33149689 PMCID: PMC7605603 DOI: 10.2147/cmar.s271806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/06/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The aim of this study was to investigate the clinical characteristics and management of malignant ovarian tumors during pregnancy, as well as the feto-maternal outcomes and analyze the influential factors on the pregnancy outcomes. Patients and Methods Eighty-five patients with ovarian malignancies during pregnancy treated at 12 tertiary hospitals between 2009 and 2019 were analyzed in this study. The clinical features, histopathological characteristics, clinical management, and maternal and perinatal outcomes were retrospectively analyzed. The clinical features and managements were compared between abortion group and live birth group. Results The following diagnoses were made: 41 (48.24%) patients with borderline ovarian tumors, 18 (21.18%) patients with epithelial ovarian cancers, 17 (20.00%) patients with non-epithelial ovarian malignancies and 9 (10.59%) patients with metastatic ovarian tumors. Thirty-six (42.45%) patients underwent conservative surgical treatment. Thirty-four (40.00%) patients opted for fertility-sparing surgery, and fifteen (17.56%) patients received radical surgery. Chemotherapy was administered to 32.94% of the patients. The proportion of ovarian malignancies diagnosed in the first trimester in the abortion group was higher than that in the live birth group (P<0.05). However, tumor diameter, reproductive history, stage and surgical indications showed no significant differences between groups. A total of 67 live babies were recorded in this study, including 19 premature babies and 1 full-term newborn who died of respiratory distress. All of the BOTs were diagnosed with stage I, among whom 38 (92.68%) patients exhibited disease-free survival. Twenty-eight ovarian cancers were in stage I–II and 26 of them had disease-free survival with the longest follow-up time of 10 years. Five of the sixteen patients in advanced stage (stage III–IV) died, four of whom had metastatic tumors. Conclusion Pregnant women with early-stage malignant ovarian tumors appear to have favorable outcomes. Conservative surgery is acceptable for early-stage borderline ovarian tumors during pregnancy. The gestational age of ovarian malignancy detection is key for pregnancy outcomes.
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Affiliation(s)
- Liya Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Shenjiao Huang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, People's Republic of China
| | - Xiujie Sheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Major Obstetric Diseases of Guangdong Province, Guangzhou 510150, People's Republic of China
| | - Chenchen Ren
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Qiming Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Ningbo City, Ningbo 315012, People's Republic of China
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining 272029, People's Republic of China
| | - Shuping Zhao
- Department of Gynecology, Women and Children's Hospital of Qingdao, Qingdao 266000, People's Republic of China
| | - Tianmin Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated of China Medical University, Shenyang 110004, People's Republic of China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Pengming Sun
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Yang Lin
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130000, People's Republic of China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
| | - Jiandong Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, People's Republic of China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Municipal Key Clinical Specialty, Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, People's Republic of China
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Poulain M, Vandame J, Tran C, Koutchinsky S, Pirtea P, Ayoubi JM. Fertility preservation in borderline ovarian tumor patients and survivors. Horm Mol Biol Clin Investig 2020; 43:179-186. [PMID: 32628631 DOI: 10.1515/hmbci-2019-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/02/2020] [Indexed: 12/24/2022]
Abstract
Borderline ovarian tumors (BOTs) represent around 15% of all epithelial ovarian cancer. Around one third of those patients is under 40 and has not completed childbearing when the tumor is diagnosed. Cancer survivors are more and more concerned about their future fertility since a large proportion of those with BOTs are young. Whatever the tumor stage, information regarding future fertility after treatment and fertility preservation (FP) options must be delivered to all patients before treatment. A multidisciplinary team will discuss and propose personalized treatment and FP strategies. Nowadays, the FP options offered to patients with BOT are the followings: i) minimal invasive conservative surgery, ii) oocyte cryopreservation after controlled ovarian stimulation (COS) or in vitro maturation (IVM) and iii) ovarian tissue cryopreservation. Generally, the most common strategy to preserve future fertility is represented by minimal invasive conservative surgery. However, with the remarkable success and evolution of assisted reproductive technologies (ART) - notably progress and efficiency in COS and oocyte vitrification - have led to offer another potential approach for FP consisting in oocyte cryopreservation. Several COS protocols, such as random start or dual stimulation associating tamoxifen or aromatase inhibitors with gonadotropins provide similar results when compared to standard protocols while providing safety by minimizing the risk of high estrogen exposure. When COS is contraindicated, oocyte cryopreservation can still be possible throw IVM. Even though, oocyte competence after IVM is lower than that obtained after COS. A less used approach is cryopreservation of ovarian tissue, consisting in freezing ovarian cortex fragments for a future thawing and graft. Some concerns and limitations regard the ovarian cortex graft and the risk of reintroducing malignant cells once performed. Nonetheless, the latter it is the only option in prepubertal patients.
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Affiliation(s)
- Marine Poulain
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
- Université Paris Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France - ENVA, BREED, 94700, Maison-Alfort, France
| | - Jessica Vandame
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
| | - Chloé Tran
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
| | - Sonia Koutchinsky
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
| | - Paul Pirtea
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
- Université Paris Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France - ENVA, BREED, 94700, Maison-Alfort, France
| | - Jean-Marc Ayoubi
- FOCH Hospital, Gynecology Obstetric and Reproductive Medical Unit Department, Suresnes, France
- Université Paris Saclay, UVSQ, INRAE, BREED, 78350, Jouy-en-Josas, France - ENVA, BREED, 94700, Maison-Alfort, France
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Gerasimova AA, Shamarakova MV, Klimenko PA. Borderline ovarian tumors in pregnancy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Borderline ovarian tumors (BOTs) are common in women in their reproductive years. In more than one-third of patients tumors are detected at the age of 15–29, the average age at initial diagnosis is 40. The study was aimed to improve methods for BOTs diagnosis in pregnancy and to determine the possibilities of organ preservation treatment. A group of 300 pregnant women with various tumor-like formations and ovarian tumors was examined. Of them, 25 patients had borderline epithelial tumors (22 patients had serous and 3 patients had mucinous tumors). Ultrasound examination together with blood serum CА-125, sFas, VEGF and IL6 level assessment were performed prior to surgery. The results obtained were compared with the results of morphological studies. Organ preservation and radical surgical treatment were carried out, and chemotherapy, if necessary. Perinatal outcomes were studied when performing the cross-comparison. It was discovered, that ultrasonography and logistic regression analysis made it possible to distinguish between benign ovarian tumors, BOTs and malignant ovarian tumors. The levels of VEGF above the 500 pg/ml, IL6 above the 8.1 pg/ml and CА-125 above the 300 U/ml indicated the high probability of malignant ovarian tumors in pregnant women. Only the morphological study of ovarian tissue, obtained regardless of surgical methods, ensured understanding of the ovarian tumor’s true nature during pregnancy. At the same time, in three pregnant women with ovarian tumors, the morphological examination revealed some tissue areas common both for BOTs and malignant ovarian tumors. Thus, the predominance of the tumor early stages, relatively mild course and, favorable prognosis in patients with BOTs make it possible to use gentle surgical treatment making it possible to preserve menstrual function and fertility.
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Affiliation(s)
- AA Gerasimova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - MV Shamarakova
- Center for Family Planning and Reproduction, Moscow, Russia
| | - PA Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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18
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[Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Pregnancy]. ACTA ACUST UNITED AC 2020; 48:322-329. [PMID: 32004783 DOI: 10.1016/j.gofs.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the place of imaging, tumour markers, type of treatment and surgical route, follow-up, delivery mode, and re-staging in case of BOT during pregnancy, in order to provide guidelines. METHOD A systematic bibliographical analysis on BOT during pregnancy was performed through a PUDMED search on articles published from 1990 to 2019 using keywords « borderline ovarian tumour and pregnancy ». RESULTS Pelvic ultrasound is the gold standard and first-line examination for the detection and characterization of adnexal masses during pregnancy (grade C). Pelvic MRI is recommended from 12 gestational weeks in case of indeterminate adnexal masses and should be concluded by a diagnostic score (grade C). Gadolinium injection should be minimized because of proven risk to the fetus and should be discussed on a case-by-case basis after patient information (grade C). In the absence of data in the literature, it is not possible to recommend the use of any tumour marker for the diagnosis of BOT during pregnancy. In case of a surgical treatment of BOT during pregnancy, there is insufficient evidence to recommend either a cystectomy or an oophorectomy. For BOT, the laparoscopic approach should be preferred during pregnancy if it is feasible (grade C). Surgical route and type of surgery should be chosen after taking into account the tumour size, the obstetrical term, and the subsequent desire for pregnancy, following discussion in a multidisciplinary meeting. In the absence of sufficient data in the literature, it is not possible to make any recommendation on the follow-up of a BOT suspected during pregnancy. There is not enough evidence in the literature to change obstetrical management for delivery in patients with BOT. In case of incomplete staging of a BOT treated during pregnancy, restaging can be discussed as for non-pregnant patients (grade C). CONCLUSION The diagnosis of BOT occurring during pregnancy remains rare despite systematic screening of adnexal masses in the first trimester of pregnancy and an increasing maternal age. There is limited data in the literature concerning the management of BOT during pregnancy. All decisions must be taken after discussion in a multidisciplinary meeting.
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Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018; 12:1-9. [PMID: 29988841 PMCID: PMC6032492 DOI: 10.1016/j.jare.2018.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
The management of gestational ovarian cancer can be challenging because of the risk of fetal wastage, and the possibility of treatment-related complications to the fetus; it is based on insufficient data from retrospective studies and case series. Here, a literature review of the diagnostic and surgical approaches to the gestational ovarian cancer has been performed; moreover, data on safety of chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes, have also been reviewed. Up to now, 193 cases of ovarian cancers during pregnancy have been reported in the English literature. Treatment of ovarian malignancies during pregnancy depends on histology, stage, and gestational weeks. When possible, surgical excision is indicated, and fertility-sparing surgery can be offered to stage I epithelial ovarian tumours (EOC), germ cell ovarian, or sex-cord stromal ovarian tumours. Neoadjuvant and/or adjuvant chemotherapy for advanced ovarian tumours is indicated as in non-pregnant women. Administration of chemotherapy after the first trimester, can cause fetal growth restriction, while being seemingly safe. The therapeutic approach of ovarian cancer in pregnancy should be individualized and intended in specialized centers.
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Affiliation(s)
- Stergios Boussios
- Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
- Corresponding author.
| | - Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London W1G 6AD, UK
| | - Konstantina Tatsi
- Gynaecology Unit, General Hospital “G. Hatzikosta”, Makrigianni Avenue, 45001 Ioannina, Greece
| | - Alexandros K. Tsiouris
- Department of Biological Applications & Technology, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
| | - Nicholas Pavlidis
- Medical School, University of Cyprus, Old road Lefkosias Lemesou, No. 215/6, 2029 Aglantzia, Nicosia, Cyprus
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Haddad S, Selleret L, Fedida B, Benjoar M, Beldjord S, Thomassin-Naggara I, Bazot M. Masses annexielles et grossesse : quelle imagerie et quels diagnostics ? IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thomassin-Naggara I, Fedida B, Sadowski E, Chevrier MC, Chabbert-Buffet N, Ballester M, Tavolaro S, Darai E. Complex US adnexal masses during pregnancy: Is pelvic MR imaging accurate for characterization? Eur J Radiol 2017; 93:200-208. [PMID: 28668416 DOI: 10.1016/j.ejrad.2017.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To retrospectively evaluate the accuracy of pelvic magnetic resonance (MR) imaging for the characterization of complex sonographic adnexal masses discovered in women during pregnancy. STUDY DESIGN The study population comprised 31 pregnant women (median age: 32 years (range: 19-42); mean gestation age of 16 weeks) referred to our institution for MR imaging for characterization of an adnexal mass discovered incidentally during routine ultrasound (US) for other indications. The population comprised of 31 women, with 36 adnexal lesions (mean size: 103mm [range: 20-290]), of which 27 were benign and 9 were malignant masses. Prospective US and MR reports were reviewed to determine the presence of a benign or malignant lesion. Two radiologists (R1 and R2) blinded to the final outcome, retrospectively evaluated the MR images using the criteria based on the ADNEXMR-SCORE and classified the lesion as benign or malignant. The reference standard was surgical pathology or at least a 1-year imaging follow-up. RESULTS Prospective US and MR imaging correctly identified the diagnosis in 27/36 (75%) (95% confidence interval (CI): 58.9%-86.2%) and in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions, respectively. MR imaging with ADNEXMR-SCORE allowed a correct diagnosis in 32/36 (88.9%) (95% CI: 74.6%-95.6%) of lesions for R1 and in 30/36 (83.3%) (95% CI: 68.1%-92.1%) of lesions for R2. The sensitivities and specificities of MR imaging using the MR ADNEXMR-SCORE were 100% (95% CI: 70.1%-1000%) for both readers and 85.1% (95% CI: 67.5%-94%) and 77.7% (95% CI: 59.2%-89.4%) for R1 and R2, respectively. No malignancy was classified as benign using MR criteria. The reproducibility between the two readers was almost perfect, with a kappa of 0.914. CONCLUSION MR imaging is highly accurate for the characterization of complex adnexal masses incidentally discovered during pregnancy. CLINICAL RELEVANCE MR imaging can accurately characterize adnexal masses in pregnancy and could be useful in opting for expectant management until delivery.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France.
| | - Benjamin Fedida
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Elisabeth Sadowski
- University of Wisconsin, Departments of Radiology, Obstetrics and Gynecology Clinical Science Center, E3/372, 600 Highland Avenue, Madison, WI 53792-3252, United States
| | - Marie-Claude Chevrier
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Nathalie Chabbert-Buffet
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
| | - Marcos Ballester
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
| | - Sebastian Tavolaro
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris, France
| | - Emile Darai
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstetrique, 4 rue de la Chine, 75020 Paris, France
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Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety. Obstet Gynecol Surv 2017; 72:184-193. [PMID: 28304416 DOI: 10.1097/ogx.0000000000000407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy. Objectives The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes. Evidence Acquisition A detailed literature review was performed on PubMed. Results The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes. Conclusions A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman. Relevance This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.
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Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:58-72. [DOI: 10.1016/j.bpobgyn.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/27/2022]
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Abstract
Several theories have been proposed to explain the origin of epithelial neoplasms of the ovary. However, most of them did not receive serious consideration until recently when it has been proposed that most ovarian neoplasms arise from the fallopian tube. In this review, we mention the different theories, we discuss in detail the fallopian tube theory, and the reasons why this theory is probably inaccurate. We are also proposing a new theory, the fere ex nihilo, based on the observation of numerous cases, old and new concept, and experimental works with animals. We believe that, most probably, ovarian epithelial neoplasms are related to hormones and the identification of these hormones will allow us not only to diagnose and treat these lethal neoplasms, but also to prevent them.
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Cosentino F, Turco LC, Cianci S, Fanfani F, Fagotti A, Alletti SG, Vizzielli G, Vitale SG, Laganà AS, Padula F, Coco C, Pisconti S, Scambia G. Management, prognosis and reproductive outcomes of borderline ovarian tumor relapse during pregnancy: from diagnosis to potential treatment options. J Prenat Med 2016; 10:8-14. [PMID: 28725340 DOI: 10.11138/jpm/2016.10.1.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND fertility sparing surgery is the first option for treatment of childbearing age women affected by borderline ovarian tumor (BOT). This review put in evidence the benefits and the risks of conservative surgery procedure. Moreover, the literature review is aimed to analyze the possibility of fertility sparing surgery in BOTs and to define a standard treatment in the management of this pathology during pregnancy. METHODS systematic analysis of the relevant literature for fertility sparing during pregnancy for BOT, accessed through MEDLINE (1982-2015), bibliographies, and interactions with investigators. The data were assimilated into a rigorous and objective contemporary description, enriched by prospective, controlled, and evidence-based studies. RESULTS there are not many studies about BOT during pregnancy. It can reasonably assumed that after the diagnosis of a suspected BOT during the third trimester of pregnancy, an attitude of close surveillance could be adopted. To the best of our knowledge, we report the only case in literature focused about the treatment and management of borderline ovarian tumor relapse detected during pregnancy. CONCLUSION basing on our experience and on literature reported, the conservative management of BOT during gestation up to delivery could be considered feasible. The conservative debulking surgery should be performed at the time of cesarean section in a third referral center for gynecologic oncology.
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Affiliation(s)
- Francesco Cosentino
- Division of Gynecologic Oncology, Department of Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Catholic University of the Sacred Hearth, Campobasso, Italy
| | - Luigi Carlo Turco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Stefano Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Chieti Gabriele D'Annunzio, Chieti, Italy
| | - Anna Fagotti
- Division of Minimally Invasive Gynecological Surgery, St. Mary Hospital Terni, University of Perugia, Terni, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Italy
| | - Francesco Padula
- Department of Gynecologic Ultrasound Imaging, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Claudio Coco
- Department of Gynecologic Ultrasound Imaging, Altamedica Fetal Maternal Medical Centre, Rome, Italy
| | - Salvatore Pisconti
- Medical Oncology Unit, Azienda Ospedaliera SS. Annunziata, Taranto, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy
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Abstract
Diagnosis of ovarian mass during pregnancy is a rare event. Treatment of ovarian malignancies during pregnancy depends on histology, grade, stage, and gestational weeks. When possible, surgical excision is indicated, and sometimes, fertility-sparing surgery is recommended. Administration of systemic treatment before or after surgery is indicated as in nonpregnant women. Preliminary data suggest that platinum salts and taxanes are safe during pregnancy. Management of ovarian tumors in pregnancy requires a multidisciplinary approach to guarantee an optimal treatment for the mother and the fetus.
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Telli E, Yalcin OT, Ozalp SS, Hassa H. Surgical intervention for adnexal masses during pregnancy. BMJ Case Rep 2013; 2013:bcr-2013-010324. [PMID: 23814228 DOI: 10.1136/bcr-2013-010324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.
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Affiliation(s)
- E Telli
- Department of Obstetrics and Gynecology, Osmangazi University, School of Medicine, Eskisehir, Turkey.
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Borderline Ovarian Tumor during Pregnancy: A Case Report. Case Rep Obstet Gynecol 2013; 2013:160319. [PMID: 23662224 PMCID: PMC3639691 DOI: 10.1155/2013/160319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/25/2013] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 33 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. An abdominal MRI was performed afterwards and it revealed a pelvic mass, developing from the right ovary, with a liquid component but with a major solid area. CA 125 was within the normal range values. A laparotomy followed by right salpingo-oophorectomy was performed at 14 weeks of gestation and both the frozen section and the definitive histology revealed a borderline mucinous ovarian tumor. Ovarian tumors of low malignant potential comprise 10%–20% of all ovarian malignancies. They carry an excellent prognosis with 95%–99% long-term survival. Whereas in the past, radical surgery (hysterectomy and bilateral salpingo-oophorectomy with peritoneal staging) was standard regardless of the age of the patient, unilateral salpingo-oophorectomy with or without staging has become the recommended management for women who desire childbearing. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients.
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